Using ¹⁸F-FDG and ¹⁸F-DOPA PET/CT as prognosis indicators of pediatric patients with neuroblastoma.

Objectives Neuroblastoma is the most common extracrainial solid malignancy in pediatric population with varying outcomes. In this preliminary study, SUVmax and volumetric parameters of ¹⁸F-FDG and ¹⁸F-DOPA PET/CT were compared to predict the bone marrow involvement and death.

Methods Nineteen children (age 3.4±4.3y) with primary diagnosis of neuroblastoma were retrospectively included. All children underwent pretreatment ¹⁸F-FDG and ¹⁸F-FDOPA PET/CT. A region of interest was manually drawn on the primary tumor according to the anatomical contour on CT. Metabolic indices such as SUVmax, total lesion glycolysis (TLG) of ¹⁸F-FDG and total lesion DOPA uptake (TLD) of ¹⁸F-DOPA were measured. ROC analysis and Kaplan-Meier method were used to determine the prognostic significance of these parameters.

Results The median follow-up period was 31.8 mo (9-73 mo). Five of patients were nonsurvivors and had higher FDG SUVmax (8.6±2.1, P=0.02). The AUC of ROC analysis of FDG SUVmax, DOPA SUVmax, TLG and TLD were 0.87, 0.79, 0.79 and 0.51, respectively. The ratio of FDG SUVmax/DOPA SUVmax and TLG/TLD had AUC as 0.94 and 0.93, respectively. Patients with lower DOPA FDG (<3.9, P=0.02), higher FDG SUVmax (>4.8, P<0.01), higher TLG (>206, P=0.04), higher FDG/DOPA SUVmax ratio (>1.65, P<0.01) or higher TLG/TLD ratio(>1.66, P<0.01) had significantly lower survival rate.

Conclusions Patients with higher FDG uptake or lower DOPA uptake can be served as indicators of poor survival. Both SUVmax and TLG of FDG could be used to set cutoff, while TLD of DOPA failed to discriminate between survivors and non-survivors.